Dr. Roach: Elderly man questions amount of shrinkage

Keith Roach
To Your Health

Dear Dr. Roach: I’m an 81-year-old man. About two years ago, I began to realize that my testicles were shrinking, and they are now about the size of a marble. I have asked my primary care doctor and urologist about this, and the reply is that nothing can be done about it.

I have read that boxer shorts are recommended to keep the testicles cooler and healthier. I am wondering whether my extensive time sitting at a desk and reading could be related to my shrinking testicles. Or is it related to erectile dysfunction, which is caused by decreased blood flow? I have ED. My last testosterone result was about 500. Is there nothing that can be done, not even any exercises?

— L.D.

Dear L.D.: The medical term for what’s happening to you is “testicular atrophy,” and it has several possible causes. Age alone is one: At age 81, many men have noticed some shrinkage in testicular size, but yours is beyond the norm. You are right that cooler temperatures are healthier for the testicles, but again, I am a little surprised by the severity of your description.

Among the other common causes are a history of trauma or infection. However, any underlying cause can also affect the ability of the testicles to make testosterone. Your blood testosterone level is surprisingly normal for your age (400-500 is the average for a man in his 80s). A low testosterone is a common cause of erectile dysfunction (poor blood flow is only one cause of ED).

After two years, it is very unlikely that any treatments will affect the testicles now, unfortunately.

Dear Dr. Roach: I’m a 91-year-old male who makes frequent visits to the bathroom to urinate. I am in good health and I wonder what causes this. Where does all that liquid come from?

— A.R.N.

Dear A.R.N.: What goes in must come out. All the liquid you urinate came from fluid you consumed when drinking and eating food.

But it may be more about perception than volume. Frequent urination is extremely common in both men and women, and although some causes are the same, such as an overactive bladder, men have an additional anatomical structure that can lead to urinary problems as they get older: the prostate, a normally walnut-sized gland that may increase in size as men age. It is through the prostate that the urethra, and thus all the urine, has to flow. If the prostate is enlarged, the urinary flow slows down.

As the prostate obstruction becomes worse, men may have trouble emptying the bladder completely. This has the effect of making men go to bathroom more frequently, since the bladder has less functional size. In this case, you aren’t urinating any more volume than before, just more often in smaller amounts.

Treatment needs to be directed at the underlying cause. Overactive bladder and enlarged prostate have similar symptoms and different treatments.

It is possible that you really are having excess volume, however. Diabetes is the biggest concern here, and you should be tested if you have truly large volumes of urine.

Readers may email questions to ToYourGoodHealth@med.cornell.edu